Category Archives: precepting

Risks, Benefits, and the “Invisible Bag”

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Richard F. Mitchell, MD, MS

“Did you discuss prostate cancer screening with your patient?”

“I did, but…”

“But what?”

“Well, it was strange, but as I was discussing the risks and benefits, the patient just looked at me and said, ‘This is confusing, can’t you just tell me what I should do? What would you do if it was you?’”

Has something like this happened to you while you were precepting residents? Has it happened to you when you were talking to your own patients? In this age of patient-centered care, we teach our residents to involve patients in shared decision making. How do you counsel a resident working with a patient who doesn’t want to buy into that program? How do you teach your residents to respond to the question, “If it was you, what would you do?”

You might find the answer in an invisible bag.

“There is an invisible bag right in front of you. Think ‘Santa Claus sack.’ Would you like to reach in and take something out?”

“Why would I do that?”

“It’s full of $100,000 bills.”

“Yes! Can I take two?”

“No. But there’s something else you should know. The bag also has blank pieces of paper that feel exactly like $100,000 bills.”

“That’s OK—can I put my hand in now?”

“One last bit of information before you do—it’s also full of razor blades.”

“…Ah.”

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